Provider Demographics
NPI:1346222833
Name:WARNER, BRIAN SETH (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SETH
Last Name:WARNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:812-353-2154
Mailing Address - Fax:812-353-5859
Practice Address - Street 1:2920 S MCINTIRE DR STE 350
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4215
Practice Address - Country:US
Practice Address - Phone:812-353-3277
Practice Address - Fax:812-339-2934
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000765A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400058512Medicare PIN
Q46075Medicare UPIN